A program that was supposed to help veterans see doctors closer to home more quickly is not fulfilling its promise. (Quil Lawrence, NPR News and Eric Whitney, Montana Public Radio and Michael Tomsic, WFAE,
5/16)

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Summaries Of The News:

However, McKinsey & Co.'s analysis suggests that the health law’s subsidies should prevent a “death spiral,” in which an insurance market gets caught in a cycle of increasing rates and shrinking customer pools. Meanwhile, as some insurers pull out of the federal exchanges, rural areas are sometimes left with just one option.

The Wall Street Journal:
Insurers’ Losses Deepened On ACA Plans In 2015
Many insurers have lost money on the Affordable Care Act plans they sell to consumers. A new analysis shows how much those losses deepened in 2015, the second year of the law’s signature exchanges. Based on insurers’ filings with state regulators, McKinsey & Co. estimates the health-insurance industry’s cumulative margin on individual plans last year was between -9% and -11%. That is roughly double the -4.8% margin the consulting firm calculated for 2014. For 2015, only about a quarter of insurers reported that they made a profit on their individual plans. (Wilde Mathews, 5/15)

The Wall Street Journal:
Insurance Options Dwindle In Some Rural Regions
Health-insurance customers in a growing number of mostly rural regions will have just one insurer’s plans to choose from on the Affordable Care Act’s exchanges next year, as some companies pull out of unprofitable markets. The entire states of Alaska and Alabama are expected to have only one insurer on the health law’s signature online marketplaces next year, according to state regulators. The same is expected to be true in parts of several other states, including Kentucky, Tennessee, Mississippi, Arizona and Oklahoma, state regulators said. (Wilde Mathews and Armour, 5/15)

The Baltimore Sun:
Health Insurers Seek Rate Increases In Maryland As United Healthcare Quits Market
The unanticipated costs of providing health care to customers on the state's online exchange has prompted large insurers to seek rate increases of up to 30 percent while one insurer decided not to offer individual plans at all. United Healthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017. Insurance Commissioner Al Redmer confirmed that the company was leaving the exchange created under the Affordable Care Act, as it has in most states across the country. It will continue to offer plans in the small-business market. (McDaniels and Cohn, 5/13)

Under the new guidance, insurers and hospitals cannot deny services based on someone's gender identity. Some advocates are disappointed, however, that the rule does not go far enough.

The Washington Post:
Obama Administration: Insurers Must Provide Services Regardless Of Gender Identity
The Obama administration unveiled two broad initiatives Friday aimed at combating discrimination against transgender Americans in schools and health-care coverage, affirming the president’s goal of elevating transgender protections to one of the central civil rights issues of his presidency. The moves, both of which had been in the works for years, prompted an immediate backlash from conservatives who disparaged the measures as government overreach. White House officials countered that they reflected one of the administration’s core principles: protecting those targeted for discrimination because of their identity. (Eilperin, 5/13)

USA Today:
Feds: Insurers Can't Discriminate On LGBT Obamacare Coverage
Insurers and hospitals can't discriminate against patients because of their gender identity under the Affordable Care Act, federal officials said Friday, but patient groups complained the rule doesn't go far enough. The Department of Health and Human Services finalized a rule that prohibited discrimination in health care based on a long list of characteristics ranging from race to pregnancy, gender identity and "sex stereotyping." It doesn't mean insurers have to cover all treatments associated with gender transitioning but they just can't outright deny them either. But the rule doesn't go far enough in clarifying what is discrimination, some say. (O'Donnell, 5/13)

The Wall Street Journal:
Obama Administration Extends Antibias Protections to Transgender People Seeking Health Care
Health officials included the transgender discrimination ban in a rule implementing an Affordable Care Act provision barring health providers from discriminating by sex or race. The rule includes broad protections for transgender people, like requiring insurers to cover treatments for transgender people that they would cover for other enrollees, and allowing people to use facilities that match their gender identity. The move on health care stopped short of granting such protections to gay, lesbian and bisexual people, showing the complexity of what constitutes illegal sex discrimination. Administration officials were considering whether they could include sexual orientation in the bias rule. Health and Human Services officials said that while they had wanted to set such protections for gay people, they were uncertain about whether they could. (Barrett and Radnofsky, 5/13)

Modern Healthcare:
HHS Finalizes Transgender Anti-Discrimination Rule
HHS could find itself facing pushback from religious hospitals seeking exemption from some of the rule's provisions, including transition-related surgeries. Others might find it difficult to comply because of costs and complications. The rule is expected to be more costly than anticipated, requiring an estimated $960 million in training and administrative costs for state and federal agencies over its first few years of implementation, the agency said. That's up from the $558 million outlined in the proposed rule. (Dickson, 5/13)

As insurers and hospitals point fingers at each other, it's the patient who ends up paying thousands unexpectedly. In other news, ER doctors weigh in on costs in a survey.

NBC News:
Hefty Surprise Medical Bills Can Be A Burden For Families
According to Consumer Reports, nearly one third of Americans who have visited a hospital in the last year have received a surprise medical bill. In Texas, more than 20 percent of hospitals considered in-network by the top 3 insurers had no in-network emergency room doctors on staff. (Sterns and Capetta, 5/13)

A Supreme Court ruling nearly 20 years ago said disabled people requiring public support were entitled to live in their community, rather than in institutions, but for many people that option is not yet a reality. In other Medicaid news, Kansas advocates are questioning plans to force enrollees to try cheaper drugs first.

The New York Times:
Confined To Nursing Homes, But Longing (And Ready) For Home
Marvin L. Dawkins was a 53-year-old AT&T manager when a blocked blood vessel left him paralyzed. It took 11 years, one lawsuit, repeated tangles over Medicaid rules — and a chance meeting on a church van — before he could extract himself from a nursing home outside Baltimore. ... Across the nation, many other Americans who could live elsewhere with help are unwillingly confined to nursing homes or long-term care facilities. Nearly 20 years after the Supreme Court ruled that disabled people requiring public support were entitled to live in their community, rather than in institutions unless medically necessary, the federal government and states are still far from achieving that goal. (Thomas, Fink and Smith, 5/13)

The Associated Press:
Mental Health Advocates Question Drug Bill
Mental health advocates are raising concerns about a bill passed by Kansas lawmakers that would require doctors to try cheaper drugs before more expensive ones for Medicaid recipients, but the bill's backers say the concerns are overblown. The process, called step therapy, is common in many private and public health insurance plans. It was key to resolving budget issues because it would reduce the state's cost of providing health care for poor residents by nearly $11 million a year. Gov. Sam Brownback is expected to sign the bill Monday. (Hellmann, 5/15)

And a surprising turn on the issue of Medicaid expansion—

The Associated Press:
In Surprising Turnabout, Oklahoma Eyes Medicaid Expansion
Despite bitter resistance in Oklahoma for years to President Barack Obama's health care overhaul, Republican leaders in this conservative state are now confronting something that alarms them even more: a huge $1.3 billion hole in the budget that threatens to do widespread damage to the state's health care system. So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from President Obama's new health care system. (Murphy, 5/16)

A new study shows that online doctors are failing to ask patients "simple, relevant questions," which have led them to misdiagnose a range of diseases.

The Wall Street Journal:
Study Of Telemedicine Finds Misdiagnoses Of Skin Problems
Researchers posing as patients with skin problems sought help from 16 online telemedicine companies—with unsettling results. Some of the online doctors misdiagnosed syphilis, herpes and skin cancer, and some prescribed medications without asking key questions about patients’ medical histories or warning of adverse effects, the researchers found. Two sites linked users with doctors located overseas who aren’t licensed to practice where the patients were located, as required by state law. (Beck, 5/15)

In a letter to House Speaker Paul Ryan, Democratic leaders blast the "secret subpoenas" of the chairwoman of the special panel, Marsha Blackburn, saying she's violating congressional rules. Elsewhere, the Roman Catholic Diocese of Albany is suing over requirements that workplace health plans cover employee abortions.

The Associated Press:
New York Diocese Sues To Rescind Insurer Abortion Mandate
The Roman Catholic Diocese of Albany has sued state insurance regulators over requirements that workplace health plans cover employee abortions. The Department of Financial Services lacks legislative authority to impose the requirements, and the mandate is unconstitutional, because it forces employers with religious and conscientious objections to abortion to help pay for them, according to the lawsuit filed in state court. (5/13)

While the cancer field is undergoing a revolution that could upend the way the disease is viewed, it's still helpful for doctors to know where in the body it started. And an oncologist realizes sometimes, when it comes to treatment, it's important for a doctor to use knowledge, wit and imagination to devise individualized therapies rather than going with the general course of action.

The New York Times:
The Cancer Almanac
In the midst of a genetic revolution that promises to scramble everything we know about cancer and how to treat it, our experience of the disease today still begins with a single question: Where did it start? That, it turns out, remains a very useful question to ask. The practice of categorizing cancer according to its point of origin within a specific organ or system grew from decades of steady discoveries made by researchers staring at stained slides under a microscope. The shape of cancer cells, they found, would often give clues about a cancer’s behavior. Broken down and sorted by appearance — some cells might be flatter, some are shaped like rings, some look more like oats — cancers were treated differently, and treatment improved. Even as doctors move to the precision of genetic research, the knowledge gained by staring at cells continues to be crucial to treatment. (Bradley, 5/12)

The New York Times:
The Improvisational Oncologist
The bone-marrow biopsy took about 20 minutes. It was 10 o’clock on an unusually chilly morning in New York in April, and Donna M., a self-possessed 78-year-old woman, had flown in from Chicago to see me in my office at Columbia University Medical Center. She had treated herself to orchestra seats for “The Humans” the night before, and was now waiting in the room as no one should be asked to wait: pants down, spine curled, knees lifted to her chest — a grown woman curled like a fetus. I snapped on sterile gloves while the nurse pulled out a bar cart containing a steel needle the length of an index finger. The rim of Donna’s pelvic bone was numbed with a pulse of anesthetic, and I drove the needle, as gently as I could, into the outer furl of bone. A corkscrew of pain spiraled through her body as the marrow was pulled, and then a few milliliters of red, bone-flecked sludge filled the syringe. It was slightly viscous, halfway between liquid and gel, like the crushed pulp of an overripe strawberry. (Mukherjee, 5/12)

Elsewhere, The Washington Post examines how few men realize how dangerous mutations to the BRCA gene could be for them —

The Washington Post:
Defective ‘Breast Cancer’ Genes Aren’t Just Dangerous For Women. They’re Also Linked To Aggressive Cancer In Men.
Joe Scholten’s sister had already beaten breast cancer and was battling ovarian cancer when she tested positive for a genetic mutation linked to both. He responded by doing something unusual: He got tested, too. That’s how the District resident discovered that he also carried the defective BRCA gene. He quickly told his brothers, other relatives and, hardest of all, his daughter. “Getting tested was a no-brainer,” he said, wondering what steps his sister would have taken if she’d learned early on about her own genetic risk. She was 54 when the ovarian cancer killed her. He realizes now that not knowing your medical pedigree is “clearly a danger.” (McGinley, 5/15)

For the Murphy family, the opioid epidemic isn't just numbers and graphs -- it's the toll it took on their family when it held one of their own in its grasp.

The Wall Street Journal:
Hooked: One Family’s Ordeal With Fentanyl
This is the human toll of the illegally made painkiller fentanyl, a synthetic narcotic that presents a new level of peril in the opioid crisis ravaging the U.S. Up to 50 times as powerful as heroin, and cheaper to produce, fentanyl is the end result of a drug trade that has proven wildly innovative and difficult to stop. ... Fentanyl-related fatalities are soaring in many parts of New England, the Midwest and the South. ... For Joel and Kathy Murphy, the downward spiral included disruption at work, marital strains and a trip through bankruptcy court—not to mention a family video that shows their son overdosing. Before it was over, Mr. Murphy was sleeping with a gun nearby. (Kamp and Campo-Flores, 5/14)

In other news, people are using a database tracking doctors' prescription habits to find ones more willing to give them opioids, Modern Healthcare looks at how punitive action affects doctors struggling with addiction, Minnesota's overdose death toll climbs and a celebrity shares his own experience with the battle —

Modern Healthcare:
When The Addict Is A Doctor
The first time Dr. Peter Grinspoon experimented with Vicodin was with a fellow medical student at Harvard. “It said, 'Careful: Causes extreme euphoria,' ” Grinspoon said. “And once we read that we were sort of destined to try it.” Then, as a primary-care physician based in Boston, Grinspoon tried to replicate the euphoria the drug indeed delivered, at first, during nine years of regular drug use. He ultimately resorted to writing prescriptions under a false name to feed his habit. It all came to a head in February 2005 when law enforcement agents came to his office and arrested him for fraudulently obtaining a controlled substance. (Johnson, 5/14)

The fetus had developed a shrunken skull, calcified brain spots and tested positive for the Zika virus. Puerto Rico has been the hardest hit so far of any American state or territory by the outbreak.

The Washington Post:
Puerto Rico Reports First Zika-Related Case Of Microcephaly
Puerto Rico is reporting its first Zika-related microcephaly case amid an outbreak of the mosquito-borne virus that has hit the commonwealth harder than anywhere else in the United States. In San Juan, Health Secretary Ana Rius told reporters Friday that a fetus turned over to U.S. health officials had severe microcephaly and tested positive for Zika. Rius declined to say whether the woman involved had an abortion or miscarried. A health department statement referred to a male fetus that showed "severe microcephaly and calcifications in the brain accompanied by Zika-wide presence of the virus." (Sun, 5/13)

The New York Times:
Puerto Rico Reports First Microcephaly Case Linked To Zika
A pregnant woman in Puerto Rico has become the first American whose fetus developed microcephaly because of a Zika infection acquired in the United States, the territory’s health department said on Friday. Dr. Ana Ríus, the island’s health secretary, said the fetus, which was not carried to term, had developed a shrunken skull and calcified spots in the brain, suggesting inflammation and cell death. (McNeil, 5/13)

In a speech to health care industry officials, Federal Trade Commission Chair Edith Ramirez says prices for an average in-patient stay can be almost $2,000 higher in areas where a hospital monopoly exists. Media outlets report on other hospital news from California, Connecticut and North Carolina.

The Washington Post:
This Health-Care Trend Could Make Your Hospital Stay $2,000 More Expensive
Consolidation in the health-care industry is accelerating and has helped drive up prices in parts of the country, Edith Ramirez, chair of the Federal Trade Commission, said in a speech Friday. “I remain very concerned about the rapid rate of consolidation among health-care providers,” Ramirez said. Last year, the number of hospital mergers increased 18 percent compared with the previous year, she said. In areas where there is a hospital monopoly, prices are 15 percent higher than those in areas with four or more competitors, and the average in-patient stay in those places is almost $2,000 higher, Ramirez said. (Merle, 5/13)

Los Angeles Times:
State Found Lapses In Infection Control At UCLA And Cedars
After "super bug" outbreaks last year involving a hard-to-clean medical scope, state health inspectors descended on two of Los Angeles’ largest hospitals and found numerous safety violations that appeared to put far more patients at risk. At UCLA Ronald Reagan Medical Center, the state declared an “immediate jeopardy” – meaning lives were at imminent risk – on March 4, 2015, after finding staff using contaminated water and a tainted liquid cleaner dispenser being used to ready colonoscopes and other devices for the next patients. (Petersen, 5/14)

The Connecticut Mirror:
Introducing The Mirror’s Hospitals Database
On average, 78 percent of hospital beds in the state were filled during the 2014 fiscal year, and patients stayed an average of five days. Connecticut’s acute care hospitals earned an average margin of 6.22 percent that year. And overall, 42 percent of their patients were covered by Medicare, 31 percent had private insurance and just under a quarter had Medicaid. (Levin Becker, Ba Tran and Chang, 5/16)

Modern Healthcare:
UConn Health Opens New $318 Million Hospital Tower
The University of Connecticut opened its new 11-floor, 38,000-square foot hospital tower. Seventy patients on five floors, including those in intensive care, were moved Friday from their rooms inside the existing Connecticut Tower at John Dempsey Hospital in Farmington into the new University Tower. (5/14)

The Denver Post:
Hospitals, Doctors Differ On Universal Health Care In Colorado
The campaign to establish the nation's first universal health care system in Colorado may be a longshot, but insurance companies and hospitals aren't taking chances. A single donor, Anthem Inc., has kicked in $500,000 to defeat the Amendment 69 initiative, or more than three times the amount given by all proponents combined. In a classic clash, an upstart band of universal health care advocates has run up against a powerful alliance of health care businesses. (Olinger, 5/14)

The Detroit Free Press:
EPA: Are Detroit Water Controls Adequate?
A federal drinking water expert late last year raised serious concerns about Detroit’s water system, voicing worries that the city might not be doing as much as it coud to prevent lead from leaching out of old service pipes. In an e-mail written to colleagues at the Environmental Protection Agency last December, Michael Schock — a drinking water expert who is part of the EPA’s effort to address the lead crisis in Flint — said he found it “interesting” that lead levels in Flint didn’t drop more quickly after switching back to the Detroit water system, which had years before begun using phosphates as corrosion control to protect pipes. (Spangler and Egan, 5/14)

The Associated Press:
Bid To Raise California Tobacco Tax Nears November Ballot
A well-financed campaign whose backers include billionaire environmentalist Tom Steyer, medical groups and organized labor has collected enough signatures for a ballot measure to raise California's cigarette tax by $2 per pack, officials said. The Save Lives California coalition scheduled a news conference Monday at the San Diego County Registrar of Voters office to submit the first signatures in a campaign to nearly triple California's cigarette tax to $2.87 a pack. If enough signatures are verified, the measure would appear on an increasingly crowded Nov. 8 ballot. (5/16)

The Miami Herald:
Hialeah Cosmetic Surgery Clinic Has Ties To Previous Deaths, Debilitating Injuries
The Hialeah cosmetic surgery clinic where a 29-year-old woman from West Virginia suffered fatal complications on Thursday uses physicians who have maimed patients repeatedly and then discharged them to recover in hotels and even horse stables with no medical attention, according to state records. Doctors affiliated with the clinic lure out-of-town patients, mostly women, with the promise of cheap plastic surgery. But the results have been gruesome, with at least two deaths and numerous patients rushed to local hospitals with debilitating injuries and infections. (Chang and Vasquez, 5/14)

The New York Times:
Sorry, We Don’t Take Obamacare
By many measures, the [health] law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage. It has also created a host of new policies for self-employed people .... Yet even as many beneficiaries acknowledge that they might not have insurance today without the law, there remains a strong undercurrent of discontent. ... the plans are often very different from those provided to most Americans by their employers. Many say they feel as if they have become second-class patients. This disappointment is fueling renewed interest in a “public option” that would supplement current offerings. (Elisabeth Rosenthal, 5/12)

The Wall Street Journal:
The Problem With Health Care Costs: Third-Party Payment
Several recent studies have illustrated the root of health care’s cost problem: In most cases, no one person—let alone one organization—bears sole responsibility for paying the bill. Slowing the growth of health costs may well involve changing those financial incentives—but also requires changing the culture that supports the status quo. (Chris Jacobs, 5/13)

Bloomberg:
Oops! Obamacare Runs Afoul Of The Constitution
District Court Judge Rosemary Collyer has ruled for Congress in House v. Burwell, a case challenging the authority of the executive branch to pay Obamacare subsidies for which no money has been appropriated. ... What happens if the House argument is ultimately upheld, and Department of Health and Human Services is told it can’t pay the insurance companies? ... I have to assume that participation in the exchanges, already low among people who do not qualify for large subsidies, will fall even further. And moreover, that it will fall unevenly, with sicker patients remaining on the exchanges while the healthier patients drop their insurance, forcing premiums to rise even further to compensate for the sickness of the pool. (Meghan McArdle, 5/13)

The Oklahoman:
Tobacco Tax Hike, Medicaid Rebalancing Plan Needed To Save Health Care
The end is near for the legislative session and so is health care as we know it in Oklahoma. Our state's health care system is on life support. Today, we face a crisis. In less than three weeks, all Oklahomans will start experiencing a disastrous failing in our system of care, unless the Legislature acts now. The agency that administers Medicaid in Oklahoma warns it will be forced to slash medical provider rates up to 25 percent in just a few weeks. Previous funding cuts of 18 percent have already taken a heavy toll. Any new health care cuts will be catastrophic. (Craig Jones, 5/15)

The Oklahoman:
Medicaid 'Rebalancing' Plan Is Obamacare By Another Name
The Oklahoma Health Care Authority's Medicaid “rebalancing” plan is being considered by lawmakers. The plan is simply Obamacare Medicaid expansion rebranded. As conservatives concerned about fiscal responsibility, we urge lawmakers to reject it. The rebalancing scheme is a policy that expands the scope and size of the federal government and increases dependency on government programs. It removes one more state barrier that separates us from a single-payer system in the United States. And of course it would further balloon state taxpayer spending by $1 billion (at a minimum) over the first 10 years and would increase the federal debt by $10 billion. (Tom Coburn and Larry Parman, 5/15)

Los Angeles Times:
Industry Spending To Beat A Pharmaceutical Initiative Could Set A New Standard For 'Drug Money'
[O]ne measure on this November's California ballot appears poised to set a new standard for corporate spending. The so-called California Drug Price Relief Act would cap the price any state agency or healthcare program could spend on prescription drugs at the level paid by the U.S. Dept. of Veterans Affairs, which customarily receives the largest discounts of any government agency. Turning the VA’s prices into a benchmark for California could cost Big Pharma billions of dollars a year in profits, especially if the discounts were later demanded by other states or even private insurers. (Michael Hiltzik, 5/14)

The New York Times:
Congress Wakes Up To The Opioid Epidemic
The opioid epidemic is now a leading cause of death in the United States, ravaging communities across the country. At last, Congress has snapped to attention. But its recent flurry of legislation will be of little help unless lawmakers are willing to fund treatment and prevention programs. The House last week passed 18 bills related to opioids, and the Senate approved a comprehensive bill in March. The bills, which will be reconciled in a conference committee, are overdue. (5/16)

Chicago Tribune:
The Fatal Flaw In Hillary Clinton's Medicare Plan
Clinton's Medicare buy-in, the details of which have not been released (or possibly even figured out), may or may not follow her comparatively disciplined fiscal approach. ... Her proposal implies that Obamacare is not the glittering success she claims. "Aren't the exchanges supposed to offer 'affordable' coverage to these same people?" asks economist Joseph Antos of the conservative American Enterprise Institute. "What is the problem being addressed here?" (Steve Chapman, 5/13)

Modern Healthcare:
Medical Science's Debt To The Hibakusha
President Barack Obama made the correct and courageous decision to visit Hiroshima later this month with Japanese Prime Minister Shinzo Abe. The goal: to promote a nuclear-free world. ... I vividly recall the day in the spring of 1995 when I first visited Hiroshima to see the shattered concrete dome near ground zero and toured the one-sided Peace Museum. But I also visited a place where few Western correspondents ventured—the Radiation Effects Research Foundation (RERF), the successor organization to the commission jointly created by both governments in 1947 to study the effects of radiation on the hundreds of thousands of people who survived the initial bomb blasts. ... It's probably the most comprehensive medical registry on earth. (Merrill Goozner, 5/14)

The Washington Post:
Stillbirth Is More Common Than You Think — And We’re Doing Little About It
Most mornings, I awake to the sound of my 2-year-old son talking to himself in his crib. I enter his room to fetch him, stepping around the books he scattered across the carpet the night before. On the wall hang prints of a fox, a bear, an owl. I decorated this nursery — for a baby girl — three years before I had Henry. The only sign of her is a box of tiny ruffled clothes in the closet. Everything had gone well during my pregnancy with my second daughter until the final few weeks. My obstetrician found that I had more amniotic fluid than normal. When I went for an ultrasound during my 36th week of pregnancy, the screen was motionless. I thought the machine was broken. It was not. My daughter had died. (Sarah Muthler, 5/16)

STAT:
I Swallowed My Pride And Went To A Geriatrician. I'M Glad I Did.
Checking in at the front desk of the geriatric clinic, I suddenly felt I had made a ghastly mistake. At 68, I was the only one in the waiting room not accompanied by a caregiver — and one of the few not using a walker or a wheelchair. ... But I couldn’t just leave. A spate of new health problems, requiring a gaggle of doctors with no connection to one another, had persuaded me to find the right person to quarterback my care, now and in the years to come. (Jane Gross, 5/16)

Wall Street Journal:
Two Studies Draw Different Conclusions On State Of Black America
[T]here have been gains over time for black Americans on many measures, and gaps have closed between blacks and whites on measures such as homicide rates and life expectancy. Still, reality on the ground is a far different thing. There were fifty one homicides in Chicago in January and two hundred and forty two shootings. Chicago may be an especially troubled city but it is also emblematic of problems in other urban areas. (Drew Altman, 5/13)